Name:
I wish to take leave on the following
dates:
Rotation:
(Hospital/Unit)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Authorization:
Clinical
Supervisor:
(Signature)
Programme
Director:
(Signature)
Guidelines
• Residents
requesting leave must
complete and submit this form to their Clinical Supervisor and Programme
Director at least 4 weeks in
advance.
• Dates must be discussed with the
Clinical Supervisor of the respective rotation to avoid conflicts of on-call
schedules
• Leave is not available during the final 2
weeks of the months of June or December
• No vacation or
statutory days may be taken during 4 weeks rotations, however, if there are any
conflicts, please discuss this with Dr. Tom Stewart, Residency Program
Director.